Lumpectomy or Bilateral Mastectomy? P

The waiting is brutal.  My heart goes out to you.  I wish I had waited for my full results to come in. Instead, we went ahead with a lumpectomy when the preliminary results for the BRCAs came back negative. A few days after the re-excision, the other set came back positive for  PALB2 and Chek2, both of which cause BC and other cancers.  By the time the test results came in, my MO was unwilling to wait any longer to start chemo. I had to wait on doing my BMX until about 7 weeks after treatment was finished. So I had 2 surgeries that would have been unnecessary had I just gone straight to the BMX.  Ah, well. Hindsight is 20/20.

I will be honest with you. Because of the location of my tumor and its size relative to my breast, as well as negative genetic testing and no family history (other than possible lung ca. in my “150 pack-years” ex-smoker mom, esophageal ca. in an alcoholic aunt and melanoma in a sun-worshipping half-aunt), I never considered MX; and in retrospect, for me lx+rads was a good fit. Perhaps I should have also had bilateral reduction, but I am a surgery-wuss and even w/o complications it would have thrown not just a monkey wrench but a Molotov cocktail into our plans to take a Mediterranean cruise at the end of active treatment. (Sounds trivial, but after what Bob went through last summer--almost lost him twice--I was not about to deprive him and us of the trip of our dreams). Everything worked out: had a bit of an exploding SNB seroma but it was sutured and healed; no chemo recommended; short protocol of radiation; and at almost 10 mos. post-dx and 9 mos post-op, clear mammos.

BUT had my tumor been bigger or multifocal and my breast smaller, and in a central or deep location, I probably would have opted for at least an mx; add to that a history of lumps in the other breast, a family history of gynecologic cancers, a mutation such as Chek2, Palb-2 or the BRCAs, or any combo thereof, and I’d probably have opted for a BMX, complications and all. For me the dilemma would not have been whether to keep or ditch my breast, but rather whether after mx of any kind to reconstruct or go flat (and if the latter with a uni mx, how much to get the healthy breast reduced, since they just don’t make forms and mx bras that big).